More lessons on celestial mechanics

Healthcare is back on the front burner in Lincoln this session of the Legislature, with lawmakers set to consider expanding Medicaid coverage to as many as 159,000 Nebraskans by fiscal 2016.

The move would bring the state into line with the federal health care law, even though the U.S. Supreme Court has struck down the provision that would allow Washington to withhold funding from states that chose not to expand Medicaid programs.

At the same time, the Unicameral will consider a bill to pull back prenatal coverage for illegal immigrants, a law passed over Gov. Heineman's veto and which Heineman proposes defunding in his new budget.

Heineman is right to be concerned the federal government won't follow through with promised funding -- we narrowly avoided the "fiscal cliff" and the coming months, with another battle over raising the debt ceiling likely and making progress against the federal deficit a dicey proposition at best.

If funded according to plan, Nebraska will be responsible for 10 percent of the new medical program by 2020, but if any real progress is made in cutting the federal deficit, healthcare spending will have to be part of the formula.

But proponents point out that failing to participate in the federal healthcare program will deprive Nebraska of funding it could receive from Washington, and would force more and more people to use the most expensive medical care delivered.

"We already pay for health care for the uninsured, but we do so in a way that guarantees the most expensive care, often sought in the emergency room," said Sen. Jeremy Nordquist of Omaha. "When a person seeks care in the E.R. and can't pay, the cost of that care is passed on to the provider, who passes the cost of care on to the insurer, who passes the cost of that care on to all Nebraskans with private insurance."

Nordquist and other supporters say the bill would eliminate the need for county medical assistance programs -- costing $4.7 million in Douglas County, $2.8 million in Lancaster and $200,000 in Sarpy County.

Nordquist also wants to put $23 million away for the first three years, for a separate health care access fund to cover the share of Medicaid costs when federal contributions start to decline.

Sen. Bob Krist of Omaha, a Republican, noted that governors in Arizona, Nevada and New Mexico, also Republicans, are supporting the program.

"The time has passed to debate the merits of the act," Krist said. "The only debate or question left is whether the leadership in this state allows the federal government to keep our health care cash money, or seize the opportunities and bring those monies back to care for Nebraskans."

The truth is, we take care of anyone who shows up at an emergency room, regardless of whether they have a green card or an insurance card in their pocket.

The question that remains is simple: will we provide medical care when it is most economical and effective, or wait until it is too expensive and too late?